亚急性甲状腺炎和 Graves 病同时发生。

Simultaneous occurrence of subacute thyroiditis and Graves' disease.

机构信息

Department of Endocrinology, National Naval Medical Center, Bethesda, Maryland 20889-5600, USA.

出版信息

Thyroid. 2011 Dec;21(12):1397-400. doi: 10.1089/thy.2011.0254.

DOI:10.1089/thy.2011.0254

PMID:22136271

Abstract

BACKGROUND

Rare cases of Graves' disease occurring years after subacute thyroiditis (SAT) have been reported. Here, we present the first known case of simultaneous occurrence of Graves' disease and SAT.

PATIENT FINDINGS

A 41-year-old woman presented with 10 days of neck pain, dysphagia, and hyperthyroid symptoms. Neck pain had initially started at the base of the right anterior neck and gradually spread to her upper chest, the left side of her neck, and bilateral ears. Physical examination revealed a heart rate of 110 beats/minute and a diffusely enlarged tender thyroid gland without evidence of orbitopathy. There was a resting tremor of the fingers and brisk deep tendon reflexes. Laboratory values: thyrotropin<0.01 mcIU/mL (nL 0.39-5.33), free thyroxine 2.0 ng/dL (nL 0.59-1.60), free T3 6.6 pg/mL (nL 2.3-4.2), thyroglobulin 20.1 ng/mL (nL 2.0-35.0), thyroglobulin antibody 843 IU/mL (nL 0-80), thyroperoxidase antibody 130 IU/mL (nL 0-29), thyroid stimulating hormone receptor antibody 22.90 IU/L (nL<1.22), thyroid stimulating immunoglobulins 299 units (nL<140), erythrocyte sedimentation rate 120 mm/h (nL 0-20), and C-reactive protein 1.117 mg/dL (nL 0-0.5). Human leukocyte antigen (HLA) typing revealed DRB1, DR8, B35, B39, DQB1, DQ4, and DQ5. A thyroid ultrasound showed an enlarged heterogeneous gland with mild hypervascularity. Fine-needle aspiration (FNA) biopsies of both thyroid lobes revealed granulomatous thyroiditis. The thyroid scan showed a diffusely enlarged gland and heterogeneous trapping. There was a focal area of relatively increased radiotracer accumulation in the right upper pole. The 5-hour uptake ((123)I) was 6.6% (nL 4-15). The patient was symptomatically treated. Over the next several weeks, she developed hypothyroidism requiring levothyroxine treatment.

SUMMARY

This case illustrates a rare simultaneous occurrence of Graves' disease and SAT. Previous case studies have shown that Graves' disease may develop months to years after an episode of SAT. A strong family history of autoimmune thyroid disorders was noted in this patient. Genetic predilection was also shown by HLA typing.

CONCLUSION

Although the occurrence of SAT with Graves' disease may be coincidental, SAT-induced autoimmune alteration may promote the development of Graves' disease in susceptible patients. Genetically mediated mechanisms, as seen in this patient by HLA typing and a strong family history, may also be involved.

摘要

背景

已有报道称，格雷夫斯病（Graves' disease）在亚急性甲状腺炎（SAT）发生数年之后罕见发生。在此，我们报告首例同时发生格雷夫斯病和 SAT 的病例。

患者情况

一名 41 岁女性因颈部疼痛、吞咽困难和甲状腺功能亢进症状就诊，病程 10 天。颈部疼痛最初始于右侧颈前底部，逐渐蔓延至其胸上部、左侧颈部和双侧耳部。体格检查显示心率为 110 次/分钟，弥漫性肿大且触痛的甲状腺，无眼外肌病变的证据。手指有静止性震颤，深腱反射活跃。实验室检查值：促甲状腺激素<0.01mcIU/mL（nL 0.39-5.33），游离甲状腺素 2.0ng/dL（nL 0.59-1.60），游离三碘甲状腺原氨酸 6.6pg/mL（nL 2.3-4.2），甲状腺球蛋白 20.1ng/mL（nL 2.0-35.0），甲状腺球蛋白抗体 843IU/mL（nL 0-80），甲状腺过氧化物酶抗体 130IU/mL（nL 0-29），促甲状腺激素受体抗体 22.90IU/L（nL<1.22），甲状腺刺激免疫球蛋白 299 单位（nL<140），红细胞沉降率 120mm/h（nL 0-20），C 反应蛋白 1.117mg/dL（nL 0-0.5）。人类白细胞抗原（HLA）分型显示 DRB1、DR8、B35、B39、DQB1、DQ4 和 DQ5。甲状腺超声显示腺体增大且不均匀，轻度血流丰富。双侧甲状腺叶的细针抽吸活检显示肉芽肿性甲状腺炎。甲状腺扫描显示弥漫性增大的腺体和不均匀的摄取。在右上部有一个相对放射性示踪剂聚集增加的局灶性区域。5 小时摄取率（(123)I）为 6.6%（nL 4-15）。该患者接受了症状治疗。在接下来的几周内，她出现了甲状腺功能减退，需要左甲状腺素治疗。